Talking or Keeping Silent About Parental Mental Health Problems—A Grounded Theory of Parents' Decision Making and Experiences with Their Children

This grounded theory study explored parents' experiences of responding to their children's need for understanding parental mental health concerns. Fifteen parents with severe and enduring mental health difficulties participated in the study. The findings suggest four main social processes that influence parents' talk with their children about parental mental health issues, namely “Protecting and being protected,” “Responding to children's search for understanding,” “Prioritizing family life,” and “Relating to others.” Implications of the findings for clinical practice and future research are considered. In particular, the need for more family‐orientated services where parents experience parental mental health problems is highlighted.     

Healthcare providers' perspectives on parental health literacy and child health outcomes among Southeast Asian American immigrants and refugees

Low health literacy has emerged as an important area of research because of its close link with health disparities. In this study, we used a qualitative approach to investigate healthcare providers' perspectives on the health literacy of immigrant and refugee parents and its association with children's health. Sixteen health and mental health professionals serving immigrant and refugee parents and children in various clinical settings were recruited through a purposive sampling method and interviewed. Six broad themes were identified: (1) multi-dimensional components of parental health literacy; (2) parent characteristics and native country experiences; (3) host systems and their interactions impact on parental health literacy; (4) diverse aspects of help-seeking; (5) culture-based parental help-seeking; and (6) child health outcomes. Within these larger themes, the complexity of parental health literacy and its various effects on children's health outcomes among immigrant and refugee parents were evident. Future research includes more population-based quantitative studies of parental health literacy and culturally relevant clinical approaches among immigrant and refugee parents.     

Mental health interventions for children in foster care: A systematic review

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least “possibly efficacious” (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is no consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.     

Exploring changes in family functioning when a child participates in a School-Based Filial Therapy program

Child focus is a central construct within Bowen family systems theory (Bowen theory). A clinical implication is that mental health treatment focusing on a child may unwittingly reinforce the operation of child-focused processes, which undermine rather than enhance child well-being. The concept of child focus in Bowen theory presents significant implications for professionals working in school settings and in fields such as children's mental health, which are inherently child-focused. Bowen theory is the guiding theoretical framework for School-Based Filial Therapy (SBFT). SBFT is a play therapy intervention that was initially established in remote and outer-regional New South Wales, Australia in response to the low availability of children's mental health services and the significant barriers associated with caregiver engagement in children's mental health treatment. It involves trained school personnel facilitating therapeutic play sessions with children experiencing emotional–behavioural problems. The intervention occurs on school grounds, during school hours, and children's family members do not participate in the intervention. This mixed-methods study examines the impact of children's participation in SBFT upon family functioning. Interviews with caregivers (n = 10) of children who participated in 10 SBFT sessions were analysed using content analysis. Quantitative data were collected using the Differentiation of Self Inventory – Short Form and Visual Analogue Scale – Family Functioning. A Wilcoxon signed rank test was used to analyse the pre- and post-data. Qualitative outcomes indicated changes in the categories of child functioning, caregiver functioning, and extended family functioning, whilst child-focused processes remained dominant but changed in intensity and valence following SBFT.     

Outcomes of Parent–Child Interaction Therapy in an urban community clinic: A comparison of treatment completers and dropouts

This study examined outcomes of Parent–Child Interaction Therapy (PCIT) for 52 clinically referred children with oppositional behavior and their parents treated in an urban, community mental health clinic serving demographically (i.e., income level, ethnicity) diverse families. Standardized observations of parent–child interactions and parent reported measures of child behavior were collected at pre- and post-treatment. We addressed two primary research questions: (1) What are pre-treatment predictors of treatment completion? (2) What are treatment outcomes both for families who successfully completed PCIT and for treatment dropouts? Multiple logistic regression results showed a significantly greater likelihood of treatment completion related to higher parent education, male child gender, and two parent households. Among families who completed treatment, pre–post data demonstrated significant parent change in observed skill use and improvement in parent reported disruptive behaviors with medium to large effect sizes. Findings also documented early treatment benefits for families who completed the first phase of PCIT but dropped out in the final phase prior to meeting full graduation criteria. We discuss the findings and implications for community-based applications of PCIT in the context of community mental health's mission to provide effective treatment and maximize community access to services.     

Motivations to Pursue Accreditation in Children's Mental Health Care: A Multiple Case Study

Accreditation is a growing, worldwide phenomenon that has spread to a range of industries and fields, including nonprofit social services and mental health care. Thousands of organizations are accredited, but it is not known what is driving the growth of this phenomenon. Using a multiple case study design, this exploratory study aimed to understand children's mental health agencies' motivations to pursue accreditation. In‐depth interviews, focus groups, document reviews, and limited observations were conducted at five children's mental health agencies that had recently undergone or were undergoing the Council on Accreditation process. Agencies were influenced by external factors, such as policies that require accreditation, wanting to assert their positions in the field, and the need to increase funding opportunities. Other factors were internal, related to agency leadership using accreditation as a platform for change and agencies' genuine intent to improve services. Implications for agencies, accreditors, and future research are offered.     

Normal life crises and insanity—mental illness contextualised

According to a 2005 survey, the people of Rosengård, a culturally heterogeneous borough of Malmö, Sweden, utilise considerably less mental health services in relation to their estimated needs than the rest of the city's population. A study based on interviews with people living or working in the area revealed several possible reasons. Most important was their perception of what constitutes mental illness. If the cause of one's disturbed mental state is viewed as a normal life crises rather than an illness, one does not seek medical treatment. The aim of this article is to illustrate how under-utilisation of mental health services by an immigrant population can be explained by their different perceptions of what constitutes mental illness. Interventions should add concerns regarding a client's socio-economic and psychosocial needs, rather than solely follow a medical model.     

Health Care “As Usual”: The Insertion of Positive Psychology in Canadian Mental Health Discourse

The recent shift to a “positive psychological” approach that emphasizes a “health model,” rather than a “disease model,” in mental health discourses is intended both to reduce the stigma around mental health issues and to enable people to play a role in monitoring their own mental health. As a component of a larger study on access to and utilization of mental health services by immigrant women, and a partial reflection of the current ideological context of mental health policy and practice in Canada, this shift was examined by analyzing the Canadian Mental Health Association's mental health discourse as posted in Web-based text using features of critical discourse analysis. Although considered an improvement over previous approaches by some, the current mental health discourse continues to reflect ideologies that assume a universal psychology of individual mental health. Framing this research with aspects of sociocultural and postcolonial theories, this article seeks to identify the possibilities of this new discourse and expose its limitations in relation to immigrants to Canada.     

HMOs and the Future of Student Mental Health Services

Abstract

The health maintenance organization (HMO) is likely to have a prominent position under national health insurance, which will have a strong systematizing effect on the nation's health services. Over the past two years the University of Massachusetts mental health services have provided benefits at both the university and a private medical group practice. Experience has shown that a university which already provides broad services to a large student population can extend itself to the university community including its faculty and staff. Several advantages of this development, as well as some significant problems, are discussed. As the HMO grew and quality services were established, it became feasible for the private medical group to develop its own mental health component. Based on this and other experiences in mental health delivery systems, certain conclusions are drawn about the ways universities can develop HMOs and some recommendations are made for national mental health planning.     

Kinship care and service utilization: A review of predisposing,enabling, and need factors

Research has shown that relative caregivers are less likely to use formal supports and services than non-relative foster parents. However, less is known about factors influencing kinship caregivers' help-seeking behaviors and service use. This systematic review identified research studies examining factors associated with service use among kinship caregivers using key search terms in five computerized bibliographic databases and four journals. The search identified 337 potentially relevant studies. After screening and study eligibility assessments, a final sample of 13 studies was reviewed. Findings suggested that although children and their kinship caregivers were clearly in need of services, service use was low. Results suggested a need for more rigorous research designs and that the following factors may influence service use: child behavioral problems, caregiver mental health status, resources, provider characteristics, caregiver perceived need, and social support. More research examining help-seeking behaviors, perceptions of formal services, and effectiveness of kinship caregiver services in relation to child outcomes is needed to improve the wellbeing of kinship families in the child welfare system.     

Managerial audit and community mental health: a study of rationalising practices in Finnish psychiatric outpatient clinics

In many European welfare states the reform of mental health services has been accompanied by the implementation of new forms of governance, including the introduction of managerial audit systems. While such systems have been developed for ‘good causes’, such as quality assurance, financial management and monitoring staff performance, they may simultaneously produce diverse and contradictory effects on practice. The aim of this article is to examine the role of one managerial audit system, introduced in psychiatric outpatient clinics in central Finland, and assess its impact on practice. Reference is made to modernising mental health policy in the UK as that has producedsimilar practics outcomes. The research was an empirical study of practice using a mixed-method case study design involving documentary research and semi-structured interviews. Insights from Mitchell Dean's notion of governmentalisation of government were utilised in the analysis. It was found that, although the audit system primarily served administrative needs, it began to reshape practice by reinforcing certain modes of working and excluding others. The analysis of community mental health work in Finland, with similar trends in the UK, highlights the connection between documentation, resource allocation and managerial priorities that reinforce particular styles of practice. In community mental health services it would appear that the problems of professional practice have become the problems of administration.     

Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

The impact of fathers on maltreated youths' mental health

Men are increasingly the heads of single parent households, yet are often excluded from child welfare research and practice. To better serve all families in the child welfare system, it is necessary to understand the impact of primary caregiving men on children's wellbeing. In this study we investigated the longitudinal effects of primary caregiving fathers' mental health and substance use on child mental health, and examined possible differences by child age and gender. Regression analyses were conducted with the sample of 322 youth living with a male primary caregiver at the first wave of data collection from the National Survey of Child and Adolescent Wellbeing-II (NSCAW-II). We found that father depression at baseline consistently predicted child mental health outcomes three years later, even after accounting for demographics and baseline child mental health. Surprisingly, fathers' substance use did not predict child mental health, and interactions with child age and gender were not significant. Our findings are consistent with a small but growing literature suggesting that efforts to improve engagement of and attention to fathers within research, clinical and policy efforts are likely to be worthwhile.     

Engaging with Parents in Child and Adolescent Mental Health Services

This paper asks the question: How can child and adolescent mental health clinicians constructively engage parents as a resource in the young person's treatment? It draws from qualitative research data that explore parents' experience of their involvement in their adolescent's mental health treatment program. The paper especially focuses on challenges for clinicians in engaging with parents as part of the treatment program for young people. Clinicians' input about their perceptions of interacting with parents is utilised alongside parents' experiences of their involvement in clinical processes. The clinician data revealed key challenges were managing their reactions to parent defensiveness; broadening the focus from just alleviating symptoms in the young person; not taking sides with the young person; and resisting becoming an expert instructor. The paper discusses Murray Bowen's original family research about engaging parents in treatment with the symptom bearer and addresses how clinicians can build a positive alliance with parents that avoids blame while constructively opening exploration of the family relationship process as part of a collaborative approach.     

A Social Constructivist Perspective on the Potential Relevance of Selected DSM‐5 Disorders for South African Children and Youth

In South Africa, careless implementation of child psychiatry's biomedical model of ‘mental disorder’ could stigmatise children and youth who have been made vulnerable by the lingering effects of apartheid — poverty and malnutrition, violence and abuse, and the HIV/AIDS pandemic. A focus on DSM‐5 category changes — regarding post‐traumatic stress disorder and ADHD — demonstrates that these psychiatric labels are impracticable and irrelevant in a post‐colonial developing country, where mental health care is delivered in the context of scarce services and unequal access. A social constructivist perspective enables us to broaden policy decisions and suggest directions for research.     

Ethical Issues in Child Custody and Dependency Cases

Abstract

The emotional and psychological risks to children of high conflict divorce have led to the increased involvement of mental health professionals in child custody cases. Numerous service models (Greenberg & Gould, 2001; Johnston, 2000; Johnston & Roseby, 1997) have been developed to assist divorcing families in minimizing family conflict and supporting children'S needs. This underscores the need for judges and attorneys to understand the ethical and professional standards that underlie competent mental health practice in forensic cases. The practices of mental health professionals providing court-related services may have a substantial impact on the validity of their professional opinions, the effectiveness of services provided to children and families, and children'S development and adjustment. The authors suggest core ethical and clinical issues to be considered by all psychologists who work in the context of custody disputes. It is hoped that these professional practice suggestions will also be useful to attorneys and judicial officers in assessing the quality of mental health professionals' opinions.     

“A lot of work needs to be done”—Service provider perspectives of mental health services available to Croatia- and Bosnia-born migrants

Research suggests that migrants have higher rates of mental health disorders but are less likely to access mental health services, which highlights both their vulnerability to mental illness and inequity in service provision. Despite being large and established culturally similar migrant cohorts in Australia, Croatians and Bosnians are invisible in mental health research. This qualitative study collected practice-based evidence from eight mental health service providers who have had direct professional contact with these communities, in order to understand how they engage with services, barriers to uptake and provide suggestions for service improvements. Thematic analysis was used to identify themes across interviews, which were then compared against Yang and Hwang's Migrant Mental Health Service Utilisation Model. The study identified unique factors specific to Croatia- and Bosnia-born migrants that impact how they engage with services, including mandated/prescribed services, religious resources, knowledge resources, referral pathways and procedures, and service provider competencies. This study will promote a better understanding of the limitations of the current mental health service offerings for Croatia- and Bosnia-born migrants, making it significant to practitioners, mental health organizations, policymakers and the general public.     

Non-Profit Organizations in Mental Health: Their Roles as seen in Research

Non-profit organizations (NPO) for mental health are becoming significant actors. Here, their roles in welfare society as understood in research are identified and analyzed. Results from recent research publications on the mental health field are synthesized and categorized in order to find out their origin, theoretical orientation, and view on mental health NPO’s in relation to the public welfare systems. Relevant publications are primarily from the US, empirically oriented, and addressing surveys on both individual and organizational level. NPOs were most often seen as consensus-oriented service organizations, while very few (4%) were seen as conflict-oriented advocates (i.e., anti-professional). It is concluded that these NPOs are most often studied as complements or alternatives to existing public welfare services rather than on their own terms, and that research on the topic lacks more complex theoretical attempts.